William Stanton Anderson III, M.D.
Individual provider Active NPI Family Medicine Physician · Gallup, NM
NPI 1598747909 · NPPES record last updated Mar 31, 2017
Key facts
- NPI
- 1598747909
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 11589 (SC)
- Practice address
- 516 East Nizhoni Blvd.
Gallup, NM 87301-1337 - Phone
- (505) 722-1000
- Fax
- (505) 726-8740
- NPI assigned
- Nov 19, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170407000771 | NM | Order and Referring Only - General Practice |
3678763638 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6033 | AK | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SC-Seweefamily Medicine | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 11589 | SC | Yes |
Addresses
Primary practice location
516 East Nizhoni Blvd.
Gallup, NM 87301-1337
Mailing address
1501 San Pedro Dr SE
# 182-C
Albuquerque, NM 87108-5153
Phone (505) 265-1711
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 115896 | Medicaid | SC |
Other providers in Gallup, NM
- Frances B Andablo
- Arlene Lopez Anderson
- Catharine Anderson
- Latara Anderson
- Ramona V. Anderson
- Aedra D. Andrade
- Christina Ann Andrade
- Elizabeth Andrade
- Mary Melinda Andress
- Christie Andy
All providers in Gallup, NM · Family Medicine Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.